San Diego, CA—More than half of patients with type 2 diabetes being treated with insulin to control glycemia discontinue it after hospital discharge.
The Standards of Medical Care in Diabetes—2011 guideline from the American Diabetes Association (ADA) states that insulin therapy is the preferred method of glycemic control in most clinical situations in the hospital setting, note the researchers of a retrospective medical records review presented at the 2011 Scientific Sessions of the ADA.
Using medical records obtained from the Geisinger Health System, investigators from the Analysis Group in Boston identified 1947 patients with type 2 diabetes who received insulin before a hospital discharge, had their hemoglobin (Hb)A1c levels measured before or during hospitalization, and had their glucose levels measured during hospitalization.
Of these patients, 407 had no in-hospital use of insulin. Another 1230 (63%) discontinued insulin postdischarge.
In-hospital insulin use halved the risk for insulin disruption within 60 days postdischarge and receipt of an insulin order at the time of discharge reduced the risk by 61%. Other factors associated with a reduced risk for insulin disruption postdischarge were being female; the presence of peripheral vascular disease, renal complications, or ophthalmic complications; and an HbA1c level between 7.0% and 8.0% (compared with an HbA1c <7.0%).
Factors associated with a significantly higher risk for insulin disruption within 60 days postdischarge were age >75 years (48% increased risk), the presence of depression (42% increased risk), and previous hospitalization (more than twice the risk).
“Hospitalizations provide an important opportunity for healthcare providers to educate patients about diabetes self-management,” the authors stated. “Patient education and practical discharge plans may help avert cases of inappropriate insulin disruption after hospitalization and help patients with type 2 diabetes mellitus successfully transition to the outpatient treatment setting.”
In another study by the same group of investigators, patients with type 2 diabetes with continued insulin use after discharge had significantly greater reductions in HbA1c and a reduced risk for readmission compared with those with disrupted insulin use. This study examined 2160 adults with type 2 diabetes, 1309 (60.6%) of whom had disrupted insulin therapy postdischarge.
Patients who continued insulin had an HbA1c reduction of 0.51% from baseline within 1 year postdischarge compared with a reduction of only 0.17% among those with insulin disruption. Insulin continuation after discharge was associated with an 18% reduction in all-cause hospital readmission, a 12% reduction in diabetes-related hospital readmission, and a 12% reduction in all-cause emergency department visits.